Independent Mental Capacity Advocacy (IMCA)

Our Total Voice programme provides an IMCA service for people who have been assessed as ‘lacking capacity’ to make specific decisions, primarily about serious medical treatment and long term accommodation needs. 

Who should be referred to the IMCA service?

The local authority/NHS decision maker MUST refer you if you have no ‘appropriate’ family and friends if you lack capacity to make a decision about either:

  • Serious medical treatment
  • Long term moves (more the 28 days in hospital/8 weeks in a care home)
  • Deprivation of Liberty Safeguards

The local authority/NHS decision maker MAY refer you if you lack capacity to make a decision about either

  • Care review - with no ‘appropriate’ family or friends
  • Safeguarding referral - victim or alleged perpetrator, regardless of family and friends

How do you know if someone lacks capacity?

You may be assessed as lacking the ability to make a decision, and needing an IMCA, if you cannot do one or more of the following:

  • Understand information given to you about the decision.
  • Retain the information for long enough to make the decision.
  • Use or weigh up the information as part of the decision making process.
  • Communicate your decision (by any means, e.g. talking, sign language or blinking).

The assessment must be specific to the decision which needs to be made, for example your medical treatment, not a generic test of capacity. Whether and how such assessments are recorded may vary according to the seriousness of the decision made.

Deprivation of Liberty Safeguards (DoLS)

Managing Authorities (Care Homes or NHS Hospitals) and Supervisory Bodies (Local Authority) have a duty to consult an IMCA when assessing a potential Deprivation of Liberty if there are no appropriate family or friends to consult about the decision. In some situations it may also be appropriate for an IMCA to be requested to offer support to the person deprived of their liberty, or their Relevant Person’s Representative after a DoLS authorisation has been granted.

The DoLS IMCA will ensure that all relevant factors, including the person's wishes and feelings are taken into consideration, by those making decisions about whether or not to grant a deprivation of liberty. If an authorisation has been granted the IMCA can support the person deprived of their liberty or their Representative to understand what DoLS mean and how it is affecting them. They can also support the person or Representative to challenge the authorisation if appropriate. 

You can find out more about DoLS on our IMCA page.

Relevant Person’s Representative

Within this service, we would represent a person who has been deprived of their liberty after a decision has been made that it would be in their best interests. We would ensure that the reasons for the deprivation are still relevant and that any measures that are put in place to support the person who is deprived of their liberty are being carried out.

You can find out more about our IMCA and IMCA DoLS services in our IMCA section

Download our IMCA leaflet.

How to Refer

If you are not sure whether an IMCA is relevant or not, call our referral line and we can talk you through the situation and advise you of the best route forward.

Referrals can be made by authorised staff in the local authority or the NHS to the IMCA service by answering some key questions about your capacity.